What are the treatments for ovarian cancer ?
The treatment of ovarian cancers involves a team of various specialists.
This team includes, at a minimum, an oncologist, a radiotherapist, and a surgeon, and may also involve a pathologist and a geneticist. The team meets during a Multidisciplinary Consultation Meeting (RCP) to propose the most appropriate treatment plan for the patient.
The proposed treatment will be explained in detail by the doctor in charge of the patient during a dedicated consultation, called the announcement consultation.
For simplicity, the treatments presented here primarily concern epithelial ovarian cancers, which are the most common.
Surgery is the primary treatment for ovarian cancers. The goal of the procedure is the complete removal of visible lesions. This surgery can be performed via laparoscopy, particularly for stage 1 cancers, or through laparotomy.
Expert perspective
The nature of the surgical intervention varies depending on the extent of the cancer. The surgeon may perform one of the following procedures :
- Removal of the ovaries ( oophorectomy )
- Removal of one or both fallopian tubes ( salpingectomy )
- Removal of the ovaries and fallopian tubes ( annexectomy ). When the patient is of childbearing age, the surgeon may exceptionally remove only the affected ovary and its tube.
- Removal of the uterus ( hysterectomy )
- Removal of the uterus, cervix, and upper part of the vagina ( total colpo-hysterectomy )
- Removal of the omentum, the membrane covering the stomach and large intestine ( total omentectomy )
- Removal of the omentum and spleen ( omentosplenectomy )
Regardless of the nature of the intervention, it will always include :
- A complete abdominal-pelvic exploration
- Removal of the lymph nodes located near the tumor
- Removal of the appendix ( appendectomy )
- Numerous biopsies
Surgery may be followed by chemotherapy (adjuvant treatment). A chemotherapy drug blocks the multiplication of rapidly renewing cells, such as cancer cells. The standard treatment for ovarian cancer relies on the simultaneous use of two drugs: carboplatin and paclitaxel.
These are administered intravenously every 3 weeks for 4 and a half months (6 chemotherapy cycles).
The treatment outcome will be evaluated every 2 to 3 chemotherapy cycles through clinical examination, measurement of the blood level of CA-125, and/or an abdominal-pelvic scan.
In case of recurrence, other chemotherapy drugs will be prescribed, such as topotecan, which is administered intravenously, or etoposide, which is taken orally.
Different targeted therapies may also be used to treat ovarian cancer.
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As their name suggests, these therapies specifically target molecules involved in the transformation of a normal cell into a tumor cell or in the development of cancerous cells. These molecules are found either outside or inside the cells.
Targeted therapies can be monoclonal antibodies , which are large molecules that target extracellular targets and are administered intravenously , or small molecules that target intracellular targets and are taken orally . Currently, there are around fifty different targeted therapies.
One of the targeted therapies used is bevacizumab, an antibody directed against VEGF (Vascular Endothelial Growth Factor), a growth factor for blood vessels. By blocking this growth factor, bevacizumab halts the growth of blood vessels that supply the tumor, thus preventing its development. Bevacizumab is notably used in combination with carboplatin and paclitaxel for the treatment of advanced cancers.
Other targeted therapies such as Olaparib, niraparib, or rucaparib target molecules called PARP (Poly(ADP-Ribose) Polymerase). These PARPs are enzymes involved in DNA repair. By blocking PARPs, these targeted therapies prevent the repair of DNA in cancer cells and block their proliferation. PARP-targeted therapies are particularly used to treat ovarian cancers with BRCA gene mutations (see above). They are taken orally.
Finally, significant progress has been made in the management of ovarian cancers in recent years, particularly with the use of targeted therapies and better customization of treatments according to each patient's situation.
New advancements are expected soon with the arrival of innovative treatments such as antibody-drug conjugates.
Currently, many clinical trials are being conducted with new protocols combining, for example, a targeted therapy and immunotherapy that stimulates the immune system against cancer cells.
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Article updated on Jan 10, 2025
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